Cytomegalovirus infection of the gastrointestinal tract in patients with HIV-infection

AIM: To study clinical and morphological characteristics of gastrointestinal cytomegalovirus (CMV) infection in HIV-infected subjects. MATERIAL AND METHODS: The examination of 70 HIV-infected subjects (all of them had secondary diseases, AIDS, CMV infection in the gastrointestinal tract; mean age 31.2 +/- 1.4 years) observed from 1993-2005 included conduction of flow cytofluorimetry (to assess immunity), esophagogastroduodenoscopy, colonoscopy, PCR (to assay CMV DNA in blood leukocytes), examination of biopsy and autopsy samples for CMV DNA and other pathogens of opportunistic diseases). There were 55 lethal outcomes. In autopsy, a total macroscopic and microscopic examination of the gastrointestinal tract was made. Serial histotopographic sections were studied with a wide spectrum of histological stains. RESULTS: CMV gastrointestinal lesion was diagnosed in 38.9% of 180 HIV-infected subjects who had stomatitis, pharyngitis, esophagitis, gastritis, enteritis, enterocolitis or colitis. Diagnostic criteria of viral lesion were high blood concentrations of CMV DNA, the presence of cytomegalocells, CMV DNA in biopsy or autopsy material. CONCLUSION: CMV infection manifested with severe pain, loss of weight, weakness, remitting fever. Gastrointestinal lesions were erosive-ulcerous or ulceronecrotic. The following pathogenetic chain of CMV infection course in the gastrointestinal tract was established: vasculitis--microcirculatory disorders--segmental ischemia--necrosis with inflammatory infiltration and CMV transformation of the cells--fibrosing--cicatricial transformation of the organ wall. Developing sclerosis due to CMV involvement of the intestine may promote cancer, but this should be proved in further studies. CMV gastrointestinal infection was successfully treated by cimeven (ganciclovir) and valcit (valganciclovir). The effect was achieved in 91% cases.     

Ultrasound assessed thickness of burn scars in association with laser Doppler imaging determined depth of burns in paediatric patients

This study describes the ultrasound assessment of burn scars in paediatric patients and the association of these scar thickness with laser Doppler imaging (LDI) determined burn depth. A total of 60 ultrasound scar assessments were conducted on 33 scars from 21 paediatric burn patients at 3, 6 and 9 months after-burn. The mean of peak scar thickness was 0.39 ± 0.032 cm, with the thickest at 6 months (0.40 ± 0.036 cm). There were 17 scald burn scars (0.34 ± 0.045 cm), 4 contact burn scars (0.61 ± 0.092 cm), and 10 flame burn scars (0.42 ± 0.058 cm). Each group of scars followed normal distributions. Twenty-three scars had original burns successfully scanned by LDI and various depths of burns were presented by different colours according to blood perfusion units (PU), with dark blue <125, light blue 125–250, and green 250–440 PU. The thickness of these scars was significantly different between the predominant colours of burns, with the thinnest scars for green coloured burns and the thickest for dark blue coloured burns. Within light blue burns, grafted burns healed with significantly thinner scars than non-grafted burns. This study indicates that LDI can be used for predicting the risk of hypertrophic scarring and for guiding burn care. To our knowledge, this is the first study to correlate the thickness of burns scars by ultrasound scan with burn depth determined by LDI.     

The optimal duration and delay of first aid treatment for deep partial thickness burn injuries

Using our porcine model of deep dermal partial thickness burn injury, various durations (10 min, 20 min, 30 min or 1 h) and delays (immediate, 10 min, 1 h, 3 h) of 15 °C running water first aid were applied to burns and compared to untreated controls. The subdermal temperatures were monitored during the treatment and wounds observed weekly for 6 weeks, for re-epithelialisation, wound surface area and cosmetic appearance. At 6 weeks after the burn, tissue biopsies were taken of the scar for histological analysis. Results showed that immediate application of cold running water for 20 min duration is associated with an improvement in re-epithelialisation over the first 2 weeks post-burn and decreased scar tissue at 6 weeks. First aid application of cold water for as little as 10 min duration or up to 1 h delay still provides benefit.     

Hypertension in people with diabetes and the metabolic syndrome: Pathophysiologic insights and therapeutic update

Hypertension (HTN) and type 2 diabetes mellitus (T2DM) are emerging as epidemics of the 21st century and are important components of the metabolic syndrome (MS). Evidence demonstrates a relationship between HTN, T2DM, and several vascular and metabolic abnormalities that are components of the MS. HTN affects nearly 70 million Americans and over one billion worldwide; likewise, the MS affects 44% of the US population above the age of 60 years and is rapidly increasing. HTN associated with the MS has certain pathophysiologic characteristics that provide clinical challenges. There is growing evidence that tissue activation of the renin-angiotensin system contributes to endothelial dysfunction, microalbuminuria, insulin resistance, and subsequent increased risk for cardiovascular and chronic kidney disease. The notion that HTN is a metabolic as well as a vascular disease provides a new treatment paradigm.     

Genetic architecture of the human tryptophan hydroxylase 2 Gene: existence of neural isoforms and relevance for major depression

Impaired brain serotonin neurotransmission is a potential component of the diathesis of major depression. Tryptophan hydroxylase-2 (TPH2), is the rate limiting biosynthetic isoenzyme for serotonin that is preferentially expressed in the brain and a cause of impaired serotonin transmission. Here, we identify a novel TPH2 short isoform with truncated catalytic domain expressed in human brainstem, prefrontal cortex, hippocampus and amygdala. An exploratory study of 166 Caucasian subjects revealed association with major depression or suicide of a novel single nucleotide polymorphism (SNP) g.22879A>G located in exon 6 of this short isoform. This SNP and additional SNPs were discovered through a systematic characterization of the genetic architecture of the TPH2 gene for further genetic and functional investigations of its relationship to major depression and other psychopathology.